Guided Notes

The Code Sets: ICD-10-CM, ICD-10-PCS, CPT & HCPCS

What each code set is for, who maintains it, how codes look, when they update, and which ones go on physician vs hospital claims.

Four code sets, four jobs

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Code setDescribesUsed onExample
ICD-10-CMDiagnoses (why)All claimsE11.9 type 2 diabetes w/o complications
ICD-10-PCSInpatient hospital proceduresHospital inpatient claims0DTJ4ZZ appendix removal, laparoscopic
CPT (HCPCS Level I)Services & procedures by providersPhysician & outpatient claims99213 established office visit
HCPCS Level IISupplies, drugs, equipment, some servicesMostly Medicare/Medicaid, outpatientE0114 crutches, J1100 dexamethasone 1 mg